Breadcrumbs

Gynaecology and Gynaecological Oncology Outpatient services at CALHN

The Central Adelaide Gynaecology Service provides outpatient services for patients living in the Central Adelaide Local Area Health Network (CALHN) at both The Royal Adelaide Hospital (RAH) and The Queen Elizabeth Hospital (TQEH).

The majority of inpatient care for benign related gynaecology conditions occurs at TQEH.

Clinical services provided include:

  • Colposcopy including laser and LLETZ
  • General gynaecology
  • Gynaecological dermatology
  • Gynaecological oncology
  • Menopause
  • Menopause clinic
  • Nurse led trail of void and Intermittent self-catheterisation
  • Outpatient hysteroscopy
  • Pelvic floor physiotherapy
  • Pelvic mesh (pain Trans vaginal mesh) clinic (PDF 232KB)
  • Reproductive endocrinology
  • Uro-gynaecology Incontinence
  • Urodynamic studies

Contact/referral process


Immediate referral process

Where consultation is “same day” urgent, the Gynaecology registrar or Gynaecology Oncology fellow can be contacted via switchboard to discuss patients details: 

  • RAH (08) 7074 0000
  • TQEH (08) 8222 6000 

If the condition is life-threatening, the patient should be sent to the nearest Emergency Department.

Royal Adelaide Hospital (RAH)

  • Outpatient Referral Hub: 1300 153 853
  • Outpatient referral fax number: (08) 7074 6247


Urgent referrals

A written referral marked URGENT should be faxed to RAH Outpatients and can be followed up with a phone call with one of the below:

  • Referral Hub 1300 153 853
  • Wing 1 Nurse Unit Manager Gynaecology: 0466 027 620 MUST be contacted to prioritise the patients. Every effort will be made to attend to the patient needs.
  • Gynecology registrar via switchboard (08) 7074 0000


Non-urgent referrals

  • All referrals must be in writing and sent by fax: (08) 7074 6247     

All other appointment enquiries

For new, review or change or cancellation of appointments:

  • Telephone the Outpatient Call Centre: 1300 153 853

To discuss clinically urgent or outpatient matters:

  • Contact the Nurse Unit Manager for Gynaecological Outpatients: Jessica Feeney 
    Email:  Jessica.Feeney@sa.gov.au 
    Mobile: 0466 027 620
  • Gynaecology registrar via switchboard
    Telephone: (08) 7074 0000

RAH referral forms

Location

Outpatient clinics are held in Wing 1, level 3E outpatient department. Outpatient map            

Royal Adelaide Hospital
1 Port Road SA 5000

The Queen Elizabeth Hospital (TQEH)

Outpatient referral fax number: (08) 8222 7188

For all enquiries regarding appointments including: new appointments, appointment change or cancellation call:

(08) 8222 7030 or (08) 8222 7010

Urgent referrals

A written referral marked URGENT should be faxed to:

  • TQEH Outpatients: and can be followed up with a phone call with one of the below.

To discuss clinically urgent or outpatient matters please contact:

  • The Nurse Consultant Emily Bak for Gynaecology Outpatients on 0466 479 032
  • Gynaecology registrar via switchboard on (08) 8222 6000

Location

TQEH Outpatient clinics are held on level 8A.

The Queen Elizabeth Hospital 
Woodville Road
Woodville SA 5011

Clinical urgency priorities

Gynaecology / Gynaecology Oncology priorities are based on clinical urgency as displayed below.

Immediate priority
Examples (not an exhaustive list)
Gynaecological emergencies with threat to major organs.
Refer immediately to ED
Emergency Department or appointment on the day
Ovary torsion
Ectopic Pregnancy
Pelvic Inflammatory Disease
Severe per vaginal haemorrhage

Referral process:

RAH: Must be discussed with the Gynaecology registrar or Gynaecological Oncology Fellow on call immediately via RAH switchboard on (08) 7074 0000 or Nurse Unit Manger Joya McCormack on 0466 027 620.
On-call service provided 24/7 by our Gynaecology Registrars.

A written referral marked URGENT should then be faxed to (08) 7074 6247.

TQEH: Must be discussed with the Gynaecology registrar on call immediately via TQEH switchboard on (08) 8222 6000.
If the condition is life-threatening, the patient should be sent to the nearest Emergency Department.

Urgent priority
Examples
(not an exhaustive list)

Condition has the potential to require more complex or emergency care if assessment is delayed.
Condition has the potential to have significant impact of quality of life if care is delayed

Appointment for benign gynaecology within 1 month
Appointment for gynaecology oncology pending discussion at MDM but generally within 1 -2 weeks

Dysfunctional Uterine Bleeding
Abnormal Uterine Bleeding
PMB
Abnormal smears – high grade
Post Coital Bleeding
Haemorrhaging gynaecological malignancies
Trial of void and intermittent self-catheterisation
Referral process:

RAH: Monday to Friday, 9.00 am to 5.00 pm. Must be discussed with the Gynaecology registrar or Gynaecology Oncology Fellow via RAH switchboard on (08) 7074 0000 or phone the Nurse Unit Manager Gynaecology on 0466 027 620. A referral faxed to (08) 7074 6247
TQEH: Must be discussed with the Gynaecology registrar via TQEH switchboard on (08) 8222 6000.Fax : (08) 8222 7188
Semi urgent priority
Examples (not an exhaustive list)
Condition is unlikely to require more complex care if assessment is delayed.
Condition has the potential to have some impact of quality of life is care is delayed.
Appointment between 6 to 12 weeks ( likely less)
CIN II / HPV
Abnormal vaginal bleeding
Incontinence
Poly Cystic Ovarian Syndrome
Endometriosis
Pelvic Pain
Uterine Prolapse
Pessary fitting
Fibroids, polyps
Lichen sclerosis
Lichen Planus
Dermatological Gynaecology conditions
Vaginismus
Referral process: referrals faxed to: RAH: (08) 7074 6247 or TQEH: (08) 8222 7188
Non urgent priority
Examples (not an exhaustive list)

Low priority

Appointment usually within 12 weeks as there is little waitlist in well managed clinics.

Menopause
Fertility management
PCOS
Gynaecology endocrine conditions
Fertility management including male infertility.
Ovulation induction/ tracking
Referral process: referrals faxed to: RAH: (08) 7074 6247 or TQEH: (08) 8222 7188.

RAH staff and clinic days

Clinic type and doctors vary week 1 to week 4 . Below is general representation of what clinics occur.

Day Clinic Doctors Conditions seen
Monday (am)

Urodynamic

Colposcopy
LLETZ

Gynaecological OncologyGeneral Gynaecology

Carolyn Marlow
Paul Duggan

Lino Scopacasa

Martin Oehler
Gynae Oncology Fellow
Gynae Oncology Nurse Consultant – Georgina Richter

Priti Pradhan
Gynaecology registrars

Incontinence
Bladder assessment prior to surgery

Abnormal PAP smears
Treatment for CIN II-III

All malignant gynaecological conditions for patients in CALHN and interstate

DUB
PCOS
Endometrioses
Prolapse
Pelvic inflammatory disease
Fibroids
Polyps

Monday (pm)

Hysteroscopy

General Gynaecology


Lino Scopacasa

Paul Duggan
Gynaecology registrar


PMB
DUB

General Gynaecology conditions


Tuesday (am)

Carolyn Marlow
Dermatology registrar
Gynaecology registrar
Lichen Planus
Lichen Sclerosuis
Vaginismus
General gynaecology conditions
Tuesday (pm)

General gynaecology

Reproductive endocrine

Trail of Void / intermittent self-catheterisation clinic – Nurse led

Paul Duggan
Gynaecology Registrar

Professor Robert Norman
Reproductive endocrine fellow
Reproductive endocrine nurse specialist

Gynaecology Nurse

As per general gynaecology conditions

PCOS
Gynaecology endocrine conditions
Fertility management including male infertility.
Ovulation induction/ tracking

TOV

Wednesday (am)

Gynaecological Oncology

Pelvic Floor Physiotherapist

Martin Oehler
John Miller
Lino Scopacasa
Gynae Oncology Fellow
Gynae Oncology Registrars
Gynae Oncology Nurse Consultant – Georgina Richter

Fiona Roney

Malignant gynaecological conditions

Incontinence – Women and men
Vaginismus

Wednesday (pm)

Menopause

General Gynaecology

Pelvic Floor Physiotherapist

Amita Singla
Gynaecology Menopause Registrar

Lino Scopacasa
Gynaecology registrar

Fiona Roney

Menopause
Hormonal management

General gynaecology conditions

Incontinence – women and men
Vaginismus

Thursday (am)
No Gynaecology Clinics


Thursday (pm)

Colposcopy

Laser treatment clinic

Roy Watson
Lino Scopacasa
Colposcopy Registrar
Abnormal smears / HPV
Treatment clinic for CIN II - III
Friday (am)

Colposcopy

General Gynaecology

Pelvic Floor Physiotherapist


Roy Watson
Colposcopy Registrar

Amita Singla
Gynaecology Registrar


Abnormal smears / HPV

General Gynaecology conditions

Friday (pm)

Gynaecological Oncology Long term review clinic only

Pelvic Floor Physiotherapist

Gynae Oncology Registrar

Fiona Roney

Gynaecological Oncology review clinic

Incontinence – women and men
Vaginismus

TQEH staff and clinic days

Day Clinic Doctors Conditions seen
Monday (am)

Colposcopy Clinic week 1-

Dr Roy Watson

Registrar

Emily Bak Nurse Consultant

Abnormal smears / HPV

Available as required
TOV/Pessarys

Monday (pm)

Colposcopy Clinic week 1-4

Dr Amita Singla

Abnormal smears / HPV

Tuesday (am)
Nurse Led Clinic
Emily Bak
Nurse Consultant weeks 1, 3 & 4
Available as required
TOV/Pessarys
Tuesday (pm)

General Gynae week 1-4

Dr Priti Pradhan

Dr Ray Yoong

DUB
PCOS
Endometrioses
Prolapse
Pelvic inflammatory disease
Fibroids
Polyps

Wednesday (am)

General Gynae

Nurse TOV/Self catheterisation

Dr Amita Singla wk 1

Registrar

Emily Bak Nurse Consultant

As per General Gynae

TOV/Pessarys/Self catheterisation

Wednesday (pm)

General Gynae

Dr Paul Knight week-4

Dr David Munday week 2

Registrar week 1-4

Registrar week 2

As per General Gynae

Thursday (am)

General Gynae

Reproductive Endocrine

Dr Roy Watson week 1&3

Registrar week 1&3

Prof Robert Norman week 2

Emily Bak Nurse Consultant

As per General Gynae

PCOS
Gynaecology endocrine conditions
Fertility management

Available as required Pessarys/TOV

Thursday (pm)

General Gynae

Dr David Munday week 1-4

Registrar week 1-4

Dr Paul Knight

Emily Bak Nurse Consultant

As per General Gynae

Urodynamics weeks 2,3 and 4
Incontinence/ bladder assessment prior to surgery

Friday (am)

Nurse led Clinic


Emily Bak Nurse Consultant week 2

Available as required TOV/Pessarys

Friday (pm)

No clinics



Referrals

Referrals are triaged daily into an urgent, semi-urgent or non-urgent category.

The quality of the information provided will influence when an appointment can be made and if there is insufficient information then a request will be made for a new referral before an appointment is given.

Should changes occur to a patient’s medical condition during the waiting time for an appointment, referrers should send updated clinical information and where appropriate, contact one of the following.

  • Gynaecology registrar via the:
    -  RAH switchboard on (08) 7074 0000
    -  TQEH switchboard on (08) 8222 6000
  • RAH Nurse Unit Manager on 0466 027 620
  • TQEH Nurse Consultant on 0466 479 032.

Some conditions require tests to be performed by the referring doctor prior to triage.

Investigations/test required – *(please include if patient is sexually active)

  • Full medical history

  • Full blood examination, Biochemistry
  • Urinalysis and/or MMS
  • Endocervical pap smear*
  • Pelvic/abdominal ultrasound*
  • Vaginal swabs (general and STD check)
  • List of current medication
  • Allergies

If results are not provided with the referral, they will be requested and may be delays in appointing the patient.
Specific tests are requested by the Gynaecological Oncology Fellow prior to patient discussion at the weekly Multidisciplinary Team Meeting and subsequent appointment if relevant.

Test required and pre-management strategies

Presentation
Required Investigations
Triaged to/ seen within
Notes
Abnormal Pap Smear/ Cervical screening test.
Higher risk CST
Intermediate risk CST with abnormality on last CST/Pap smear
See NHMRC Guidelines
Colposcopy
6 weeks
If menopausal, consider vaginal oestrogen while awaiting appointment.
Postcoital bleeding
Recent Pap smear. NAT testing for Chlamydia, Gonorrhoea.
Contact bleeding with normal smear does not require referral unless other clinical concerns
Colposcopy
6 weeks
Treat any infection while awaiting appointment.
Cervical polyp
Up-to-date CST (see NHMRC Guidelines)
Gynae
6 to 8 weeks
Colposcopy if abnormal smear
Pelvic pain
NAT test for Chlamydia, Gonorrhoea
Pelvic ultrasound
Urine culture or negative urinalysis.
Consider ovarian suppression with OCP
Gynae
6 to 8 weeks
Advanced laparoscopic surgeons if endometriosis felt likely
Permanent contraception
NAT testing if considering IUCD.
Nb: referrals for routine insertion/removal of Mirena will not be accepted unless potentially difficult insertion
Gynae
Next available
-
Vulval Pathology
Swabs, NAT testing, serology, virology as appropriate
Vulva clinic or colposcopy
Within 4 weeks

Bartholin’s cyst
Antibiotic treatment is of little value. Acute abscess may require referral to ED
Gynae
Within 2 weeks
Or immediate ED

Ovarian cyst

Recent ultrasound
If cyst less than 4cm diameter, repeat ultrasound in 6-12 weeks.

Age less than 35 – CA 125, CA 19.9, CEA, HCG, AFP, LDH

Age over 35 – CA 125, CA 19.9, CEA

RMI less than 200 – Gynae
6 – 12 weeks
RMI over 200, or other suspicion of malignancy – Gynae Oncology
MDT review
Appointment 1 to 2 weeks
May need to arrange repeat scan prior to being seen if features of cyst for calculating RMI are not available.
Known or suspected Gynaecological malignancy

Gynae Oncology
Immediate MDT RV
Appointment within 1 to 2 weeks


BRCA gene mutation only
High risk Breast/Gynaecology clinic
Clinic occurs alternate month, allocation dependent on patient assessment
Patients with strong family history of gynaecological malignancy can be seen for counselling

Only require referral if symptomatic
Recent Ultrasound
FBC
LDH if over 7cm diameter or rapidly enlarging

Gynaecology
8 weeks

Gynae Oncology if LDH elevated
As above


Pelvic Inflammatory Disease
FBC/ESR/CRP
Cervical swab, NAT test for Chlamydia, Gonorrhoea.
Pelvic Ultrasound
Gynaecology
Within 2 to 4 weeks
Or ED
If swabs or NAT positive, ensure treatment with appropriate antibiotics while awaiting appointment.
Vaginal discharge
FBC/ESR/CRP
Cervical swab, High vaginal swab, NAT test for Chlamydia, Gonorrhoea.
Gynaecology
With 4 weeks
If swabs or NAT positive, ensure treatment with appropriate antibiotics while awaiting appointment
Menopausal symptoms, premature menopause
If perimenopausal, two FSH/E2 levels 6 weeks apart.
Menopause clinic.
Next available

AUB – excessive or irregular menstrual loss
FBC, Fe studies. TSH. Try symptomatic treatment (eg OCP, Mirena) before referral if younger than 35.
Trans-vaginal pelvic ultrasound if age over 35 or under 35 and failed trial of symptomatic treatment
Up-to-date CST.
Gynaecology
Within 2 weeks if HB low
Other 6 to 8 weeks

Post-menopausal bleeding
Trans-vaginal pelvic ultrasound. FBC. Recent CST.

Within 4 weeks
Direct entry Outpatient Hysteroscopy clinic (RAH) after telephone assessment
Not for outpatient hysteroscopy – gynaecology clinic 4 weeks

Gynaecology
Gynae Oncology if suspicious of malignancy Colposcopy if abnormal CST.

Triage as urgent
Abnormal appearing cervix
Recent CST. Pelvic ultrasound.
NAT testing for Chlamydia, Gonorrhoea.
Nb. Significant pathology of the cervix in this setting is very unlikely. Consider whether this is a normal variant (ectropion, Nabothian cyst).
Colposcopy
6 weeks

Pelvic organ prolapse
Consider trial of vaginal oestrogen in postmenopausal women and pelvic floor exercises under physiotherapy supervision for 3-6 months prior to referral.
Urine culture or negative urinalysis.
Gynaecology.
Urogynaecology if also incontinence
Next available

Urinary incontinence, voiding difficulties
Consider trial of vaginal oestrogen in postmenopausal women and pelvic floor exercises for three months prior to referral.
Urine culture or negative urinalysis.
If solely urgency, consider trial of anticholinergic.
Bladder diary
Urogynaecology
Next available

Recurrent UTI
Urine culture
Renal and Pelvic ultrasound.
Urogynaecology
6 to 8 weeks

Subfertility
Refer after 12 months inability to conceive or if anovulatory or oligomennorhoeic.
Earlier referral may be appropriate if over 35yo,
Mid-luteal E2/Prog x 2
Semen analysis
Pelvic ultrasound
REI
Next available

Amenorrhoea/ PCOS
Recent HCG, TSH, Prolactin
Testosterone, FAI, DHEAS. FSH.
Trans-vaginal pelvic ultrasound.
Gynaecology.
REI if indicative of PCOS or wishing to conceive.
Next available

Sexual dysfunction
This is uncommonly hormonal in origin. Consider referral to counselling services.
? Gynaecology
Suggest referral to other services, such as SHINE
Patients wishing fertility preservation
Example: previous ovarian surgery, age over 35, reduced ovarian reserve.
REI
Cancer related – urgent
Other next available

Non-urgent referrals will be allocated to the next available appointment and may incur a wait. The waiting time for appointments will vary and is dependent on the demand for this service and the medical urgency of the patient’s condition.

Referrals unlikely to be offered an appointment

  • Patients that reside in other local health networks (LHN)s should be referred to Northern Adelaide LHN and Southern Adelaide LHN. Exceptions to this are direct entry into hysteroscopy, laser or Lletz clinics and women with malignant gynaecological conditions (RAH) .

  • Women will not be seen for general gynaecological checks, the only exception to this are women who require gynaecological examination couches and lifting equipment to provide care.
  • Alternate care options / health information for low priority conditions while waiting for an appointment or if no appointment is made.
  • Post discharge guidelines and information
  • If the patient or their general practitioner is concerned about a deterioration in the patient’s condition please contact the Gynaecology Registrar or call the Nurse Unit Manager of Gynaecology at the RAH or Nurse Consultant at TQEH
  • Patients whose condition has stabilised or resolved and for whom no further appointment is needed will be formally discharged. If their gynaecological health changes a new referral is needed.


^ Back to top